For years, scientists and doctors have treated vaccine skepticism as a knowledge problem. If patients were hesitant to get vaccinated, the thinking went, they simply needed more information.
But as public health officials now work to convince Americans to get COVID-19 vaccines as quickly as possible, new social science research suggests that a set of deeply held beliefs is at the heart of many people’s resistance, complicating efforts to bring the coronavirus pandemic under control.
“The instinct from the medical community was, ‘If only we could educate them,’” said Dr. Saad Omer, director of the Yale Institute for Global Health, who studies vaccine skepticism. “It was patronizing and, as it turns out, not true.”
About one-third of U.S. adults are still resisting vaccines. Polling shows that Republicans make up a substantial part of that group. Given how deeply the country is divided by politics, it is perhaps not surprising that they have dug in, particularly with a Democrat in the White House. But political polarization is only part of the story.
In recent years, public health researchers have teamed with social psychologists to look more deeply into the “why” behind vaccine hesitancy. They wanted to find out whether there was anything that vaccine skeptics had in common, in order to better understand how to persuade them.
They borrowed a concept from social psychology — the idea that a small set of moral intuitions forms the foundations upon which complex moral worldviews are constructed — and applied it to their study of vaccine skepticism.
What they discovered was a clear set of psychological traits offering a new lens through which to understand skepticism — and potentially new tools for public health officials scrambling to try to persuade people to get vaccinated.
Omer and a team of scientists found that skeptics were much more likely than nonskeptics to have a highly developed sensitivity for liberty — the rights of individuals — and to have less deference to those in positions of power.
Skeptics were also twice as likely to care a lot about the “purity” of their bodies and their minds. They disapprove of things they consider disgusting, and the mindset defies neat categorization: It could be religious — halal or kosher — or entirely secular, like people who care deeply about toxins in foods or in the environment.
Scientists have found similar patterns among skeptics in Australia and Israel, and in a broad sample of vaccine-hesitant people in 24 countries in 2018.
“At the root are these moral intuitions — these gut feelings — and they are very strong,” said Jeff Huntsinger, a social psychologist at Loyola University Chicago who studies emotion and decision-making and collaborated with Omer’s team. “It’s very hard to override them with facts and information. You can’t reason with them in that way.”
These qualities tend to predominate among conservatives, but they are present among liberals too. They are also present among people with no politics at all.
Kasheem Delesbore, a warehouse worker in northeastern Pennsylvania, is neither conservative nor liberal. He does not consider himself political and has never voted. But he is skeptical of the vaccines — along with many institutions of American power.
Delesbore, 26, has seen information online that a vaccine might harm his body. He is not sure what to make of it. But his faith in God gives him confidence: Whatever happens is God’s will. There is little he can do to influence it. (Manufacturers of the three vaccines approved for emergency use by the Food and Drug Administration say they are safe.)
The vaccines have also raised a fundamental question of power. There are many things in Delesbore’s life that he does not control. Not the schedule at the warehouse where he works. Or the way he is treated by the customers at his other job, a Burger King. The decision about whether to get vaccinated, he believes, should be one of them.
“I have that choice to decide whether I put something in my own body,” Delesbore said. “Anybody should.”
Delesbore has had many jobs, most of them through temporary agencies — at a park concession stand, at an auto parts warehouse, at a FedEx warehouse and at a frozen food warehouse. He is sometimes overcome by a sense that he will never be able to get beyond the stress of living paycheck to paycheck. He remembers once breaking down to his parents.
“I told them, what am I supposed to do?” he said. “How are we supposed to make a living? Buy a house and start a family? How?”
Like many people interviewed for this article, Delesbore spends a lot of time online. He is hungry to make sense of the world, but it often seems rigged, and it is hard to trust things. He is especially suspicious of how fast the vaccines were developed. He used to work at a factory of the drug company Sanofi, so he knows a bit about the process. He believes there is a lot that Americans are not being told. Vaccines are just one small piece of the picture.
Conspiratorial thinking is another predictor of vaccine hesitancy, according to the 2018 study. Conspiracy theories can be comforting, a way to get one’s bearings during rapid change in the culture or the economy, by providing narratives that bring order. They are finding fertile ground because of a decadeslong decline in trust in government and a sharp rise in inequality that has led to a sense, among many Americans, that the government is no longer working on their behalf.
“There’s a whole world of secrets and stuff that we don’t see in our everyday lives,” Delesbore said. “It’s politics, it’s entertainment, it’s history. Everything is a facade.”
The moral preference for liberty and individual rights that the social psychologists found to be common among skeptics has been strengthened by the country’s deepening political polarization. Branden Mirro, a Republican in Nazareth, Pennsylvania, has been skeptical of nearly everything concerning the pandemic. He believes that mask requirements impinge on his rights and does not plan to get vaccinated. In fact, he sees the very timing of the virus as suspicious.
“This whole thing was a sham,” he said. “They planned it to cause mass panic and get Trump out of office.”
Mirro, who is 30, grew up in a large Italian American family in northeastern Pennsylvania. His father owned a landscaping business and later invested in real estate. His mother battled a yearslong addiction to methamphetamine. He said she died this year with fentanyl in her bloodstream.
From an early age, politics was an outlet that brought meaning and importance. He has volunteered for presidential campaigns, watched inaugurations and gone to rallies for Donald Trump. He even went to Washington on Jan. 6, the day of the riot at the U.S. Capitol.
He said that he went because he wanted to stand up for his freedoms and that he did not go inside the Capitol or support the violence that happened. He also said he believed that Democrats have been hypocritical in how they responded to that event, compared with the unrest in cities last summer following the murder of George Floyd.
Democrats, he said, used to fight for things that were good. He has a picture of John F. Kennedy up on his wall. But they have become dangerous, he said, “canceling” people and creating racial divisions by what he sees as a relentless emphasis on racial differences.
“This isn’t the country I grew up in,” he said. “I have a love for this country, but it’s turning into something ugly.”
Vaccine skeptics are sometimes just as wary of the medical establishment as they are about the government.
Brittany Richey, a tutor in Las Vegas, does not want to get one of the vaccines because she does not trust the drug companies that produced them. She pointed to studies that she said described pharmaceutical companies paying doctors to suppress unfavorable trial results. She keeps a folder on her computer of them.
Richey said that when she was 19, she was put into a line of girls waiting for the HPV vaccine, which protects against cervical and other cancers, after a routine doctor’s appointment. She said she did not fully understand what the shot was and why she was being asked to get it.
“That’s not informed consent; that’s coercion,” said Richey, who is now 33.
Richey is also worried about the ingredients of the vaccines. She is trying to get pregnant, and she knows that pregnant women were excluded from vaccine trials. She does not want to risk it.
A portion of those who are hesitant will eventually get vaccinated. According to Drew Linzer, director of the polling firm Civiqs, fewer people are unsure about the vaccines now than in the fall, but the percentage of hard noes has remained fairly constant. As of last week, about 7% say they are unsure, he said, and about 24% say they will never take it.
Mary Beth Sefton, a retired nurse in Wyoming, Michigan, who is a moderate conservative, is not opposed to all vaccines; she usually gets a flu shot. But she worries that the COVID-19 vaccines were developed so quickly that there might be side effects that have not surfaced yet. So she has not gotten a vaccine yet despite being eligible for several months.
Sefton, who is 73 and describes herself as a person who “doesn’t like being told what to do,” says the politicization of the virus has made it hard to find information she trusts.
“The polarization makes it much harder to figure out what is real,” she said.
She thinks she might eventually get a vaccine. Her husband is bedridden, and she is his primary caregiver. And she would be cut off from some in her family if she remains unvaccinated. But she is nervous.
“I still feel exceedingly cautious,” she said. “It is a basic gut feeling.”